Two Nutrition Support Methods in Infants after Ventricular Septal Defect Repair Operation: A Case Control Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANGQi ,  TANGMin , LIUHao , DINGFang-bao , MEIJu

Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P. R. China;

Corresponding?author：

TANGMin, Email: tommy.xinhua@gmail.com

Keywords：

Congenital heart disease; Ventricular septal defect; Infant; Nutrition support method

DOI：

10.7507/1007-4848.20150185

Video：

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Objective To compare the outcome between two nutrition support methods, total enteral nutrition (TEN) and enteral nutrition combined with parenteral nutrition, in infants after ventricular septal defect (VSD) repair operation. Methods We retrospectively analyzed the clinical data of 76 infants who underwent VSD repair operation in Xinhua Hospital in 2012 year. There were 46 males and 35 females aged 1.6-11.9 (5.5±2.5) months. Nutrition support was started from the first day after operation. There were 35 patients in the group A with TEN 60 kcal/(kg·d), and 41 patients in the group B with both enteral nutrition at 30 kcal/(kg·d) and parenteral nutrition at 30 kcal/(kg·d). Results There was no statistical difference between two groups in demography data and preoperative clinical indicators. The number of patients suffered abdominal distension and gastric retention was more in the group A (22.9% vs. 4.9%, 68.6% vs. 2.4%, P<0.05). There was no difference in diarrhea. The completion of nutrition support in the group A was worse than that in the group B. In the group A, only 40% of the goal calorie was finished on the first and the second day after operation. It was improved until the third day, and the goal calorie could be finished on the seventh day. In the group B, the nutrition support method could be finished on the first day. The prealbumin level in the group B was significantly higher on the third, fifth and seventh day (P<0.05). The blood urea nitrogen (BUN) level in the two groups on the first day after operation was higher than that before operation (P<0.05), and persisted in the group A, while decreased to the normal level gradually in the group B. Following up to discharge, the weight was higher and the length of stay was shorter in the group B (P<0.05). There was no statistical difference in the cost of hospitalization between the two groups (P>0.05). Conclusion The nutrition support method, enteral nutrition combined with parenteral nutrition, is better than TEN for infants after VSD repair operation.

Citation： YANGQi, TANGMin, LIUHao, DINGFang-bao, MEIJu. Two Nutrition Support Methods in Infants after Ventricular Septal Defect Repair Operation: A Case Control Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(8): 739-743. doi: 10.7507/1007-4848.20150185 Copy

1.	Okoromah CA, Ekure EN, Lesi FE, et al. Prevalence, profile and predictors of malnutrition in children with congenital heart defects:a case-conctrol observational study. Arch Dis Child, 2011, 96(4):354-360.
2.	Herman R, Btaiche I, Teitelbaum DH. Nutrition support in the pediatric patient. Surg Clin North Am, 2011, 91(3):511-541.
3.	Toole Bj, Toole LE, Kyle UG, et al. Perioperative nutritional support and malnutrition in infants and children with congenital heart disease. Congenit Heart Dis, 2014, 9(1):15-25.
4.	Gerasimidis K, Keane O, Macleod I, et al. A four-stage evaluation of the Paediatric yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br j Nutr, 2010, 104(5):751-756.
5.	Zamberlan P, Delqado AF, Leone C, et al. Nutrition therapy in a pediatric intensive care unit:indications, monitoring, and complications. jPEN j Parenter Enteral Nutr, 2011, 35(4):523-529.
6.	Ekingen G, Ceran C, Guvenc BH, et al. Early enteral feeding in newborn surgical patients. Nutrition, 2005, 21(2):142-146.
7.	Mikhailov TA, Kuhn EM, Manzi j, et al. Early enteral nutrition is associated with lower mortality in critically ill children. jPEN j Parenter Enteral Nutr, 2014, 38(4):459-566.
8.	Delqado AF, Kimura HM, Cardoso AL, et al. Nutritional follow-up of critically ill infants receiving short term parenteral nutrition. Rev Hosp Clin Fac Med Sao Paulo, 2000, 55(1):3-8.
9.	Peter jV, Moran jL, Phillips-Hughes j. A meta analysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med, 2005, 33(1):213-220.
10.	Medoff-Cooper B, Ravishankar C. Nutrition and growth in congenital heart disease:a challenge in children. Curr Opin Cardio, 2013, 28(2):122-129.
11.	National Confidential Enquiry Patient Outcome and Death. A Mix Bag:An enquiry into the care of hospital patients receiving parental nutrition.http://www.ncepod.org.uk/2010pn.htm, 2010:1-18.
12.	黎介壽. 臨床營養支持策略的變遷. 中國普外基礎與臨床雜志,2009, 16(12):953-955.
13.	Gebara BM, Gelmini M, Sarnaik A, et al. Oxygen consumption, energy expenditure, and substrate utilization after cardiac surgery in children. Crit Care Med, 1992, 20(11):1550-1554.
14.	Teixeira-Cintra MA, Monteiro jP, Tremeschin M, et al. Monitoring of protein catabolism in neonates and young infants post-cardiac surgery. Acta paediatr, 2011, 100(7):977-982.
15.	Avitzur y, Singer P, Dagan O, et al. Resting energy expenditure in children with cyanotic and noncyanotic congenital heart disease before and after open heart surgery. jPEN j Parenter Enteral Nutr, 2003, 27(1):47-51.
16.	De Wit B, Meyer R, Desai A, et al. Challenge of predicting resting energy expenditure in children undergoing surgery for congenital heart disease. Pediatr Crit Care Med, 2010, 11(4):496-501.
17.	中華醫學會腸外腸內營養學會兒科協作組. 中國兒科腸內腸外營養支持臨床應用指南. 中華兒科雜志, 2010, 48(6):436-441.
18.	李志浩, 蘇肇伉, 陳冬英, 等. 小兒先天性心臟病術后腸道通透性的研究. 中國體外循環雜志, 2007, 5(1):7-10.
19.	Raguso CA, Dupertuis yM, Pichard C. The role of visceral protein in the nutritional assessment of intensive care unit patients. Curr Opin Clin Nutr Metab Care, 2003, 6(2):211-216.
20.	Unal D, Orhan O, Eraglu C, et al. Prealbumin is a more sensitive marker than albumin to assess the nutritional status in patients undergoing radiotherapy for head and neck cancer. Contenp Oncol (Pozn), 2013, 17(3):276-280.
21.	Wang KS, Ford HR, Upperman jS. Metabolic response to stress in the neonate who has surgery. Neoreviews, 2006, 7(8):e410-e418.
22.	McHoney M, Eaton S, Pierro A. Metabolic response to surgery in infants and children. Eur j Pediatr Surg, 2009, 19(5):275-285.
23.	Owens jL, Musa N. Nutrition support after neonatal cardiac surgery. Nutr Clin Pract, 2009, 24(2):242-249.

1. Okoromah CA, Ekure EN, Lesi FE, et al. Prevalence, profile and predictors of malnutrition in children with congenital heart defects:a case-conctrol observational study. Arch Dis Child, 2011, 96(4):354-360.
2. Herman R, Btaiche I, Teitelbaum DH. Nutrition support in the pediatric patient. Surg Clin North Am, 2011, 91(3):511-541.
3. Toole Bj, Toole LE, Kyle UG, et al. Perioperative nutritional support and malnutrition in infants and children with congenital heart disease. Congenit Heart Dis, 2014, 9(1):15-25.
4. Gerasimidis K, Keane O, Macleod I, et al. A four-stage evaluation of the Paediatric yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br j Nutr, 2010, 104(5):751-756.
5. Zamberlan P, Delqado AF, Leone C, et al. Nutrition therapy in a pediatric intensive care unit:indications, monitoring, and complications. jPEN j Parenter Enteral Nutr, 2011, 35(4):523-529.
6. Ekingen G, Ceran C, Guvenc BH, et al. Early enteral feeding in newborn surgical patients. Nutrition, 2005, 21(2):142-146.
7. Mikhailov TA, Kuhn EM, Manzi j, et al. Early enteral nutrition is associated with lower mortality in critically ill children. jPEN j Parenter Enteral Nutr, 2014, 38(4):459-566.
8. Delqado AF, Kimura HM, Cardoso AL, et al. Nutritional follow-up of critically ill infants receiving short term parenteral nutrition. Rev Hosp Clin Fac Med Sao Paulo, 2000, 55(1):3-8.
9. Peter jV, Moran jL, Phillips-Hughes j. A meta analysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med, 2005, 33(1):213-220.
10. Medoff-Cooper B, Ravishankar C. Nutrition and growth in congenital heart disease:a challenge in children. Curr Opin Cardio, 2013, 28(2):122-129.
11. National Confidential Enquiry Patient Outcome and Death. A Mix Bag:An enquiry into the care of hospital patients receiving parental nutrition.http://www.ncepod.org.uk/2010pn.htm, 2010:1-18.
12. 黎介壽. 臨床營養支持策略的變遷. 中國普外基礎與臨床雜志,2009, 16(12):953-955.
13. Gebara BM, Gelmini M, Sarnaik A, et al. Oxygen consumption, energy expenditure, and substrate utilization after cardiac surgery in children. Crit Care Med, 1992, 20(11):1550-1554.
14. Teixeira-Cintra MA, Monteiro jP, Tremeschin M, et al. Monitoring of protein catabolism in neonates and young infants post-cardiac surgery. Acta paediatr, 2011, 100(7):977-982.
15. Avitzur y, Singer P, Dagan O, et al. Resting energy expenditure in children with cyanotic and noncyanotic congenital heart disease before and after open heart surgery. jPEN j Parenter Enteral Nutr, 2003, 27(1):47-51.
16. De Wit B, Meyer R, Desai A, et al. Challenge of predicting resting energy expenditure in children undergoing surgery for congenital heart disease. Pediatr Crit Care Med, 2010, 11(4):496-501.
17. 中華醫學會腸外腸內營養學會兒科協作組. 中國兒科腸內腸外營養支持臨床應用指南. 中華兒科雜志, 2010, 48(6):436-441.
18. 李志浩, 蘇肇伉, 陳冬英, 等. 小兒先天性心臟病術后腸道通透性的研究. 中國體外循環雜志, 2007, 5(1):7-10.
19. Raguso CA, Dupertuis yM, Pichard C. The role of visceral protein in the nutritional assessment of intensive care unit patients. Curr Opin Clin Nutr Metab Care, 2003, 6(2):211-216.
20. Unal D, Orhan O, Eraglu C, et al. Prealbumin is a more sensitive marker than albumin to assess the nutritional status in patients undergoing radiotherapy for head and neck cancer. Contenp Oncol (Pozn), 2013, 17(3):276-280.
21. Wang KS, Ford HR, Upperman jS. Metabolic response to stress in the neonate who has surgery. Neoreviews, 2006, 7(8):e410-e418.
22. McHoney M, Eaton S, Pierro A. Metabolic response to surgery in infants and children. Eur j Pediatr Surg, 2009, 19(5):275-285.
23. Owens jL, Musa N. Nutrition support after neonatal cardiac surgery. Nutr Clin Pract, 2009, 24(2):242-249.

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Two Nutrition Support Methods in Infants after Ventricular Septal Defect Repair Operation: A Case Control Study

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